Predictors of readmission among elderly survivors of admission with heart failure

Section of Cardiovascular Medicine, Department of Medicine, the Yale University School of Medicine, New Haven, Connecticut, USA.
American Heart Journal (Impact Factor: 4.56). 01/2000; 139(1 Pt 1):72-7. DOI: 10.1016/S0002-8703(00)90311-9
Source: PubMed

ABSTRACT Readmission rates for patients discharged with heart failure approach 50% within 6 months. Identifying factors to predict risk of readmission in these patients could help clinicians focus resource-intensive disease management efforts on the high-risk patients.
The study sample included patients 65 years of age or older with a principal discharge diagnosis of heart failure who were admitted to 18 Connecticut hospitals in 1994 and 1995. We obtained patient and clinical data from medical record review. We determined outcomes within 6 months after discharge, including all-cause readmission, heart failure-related readmission, and death, from the Medicare administrative database. We evaluated 2176 patients, including 1129 in the derivation cohort and 1047 in the validation cohort.
Of 32 patient and clinical factors examined, 4 were found to be significantly associated with readmission in a multivariate model. They were prior admission within 1 year, prior heart failure, diabetes, and creatinine level >2.5 mg/dL at discharge. The event rates according to number of risk predictors were similar in the derivation and the validation sets for all outcomes. In the validation cohort, rates for all-cause readmission and combined readmission or death were 26% and 31% in patients with no risk predictors, 48% and 54% in patients with 1 or 2 risk predictors, and 59% and 65% in patients with 3 or all risk predictors.
Few patient and clinical factors predict readmission within 6 months after discharge in elderly patients with heart failure. Although we were unable to identify a group of patients at very low risk, a group of high-risk patients were identified for whom resource-intensive interventions designed to improve outcomes may be justified.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Heart failure is a common disease with a poor prognosis. The major causes of mortality and reduced quality of life of patients with heart failure, rooted in their poor performance, this study conducted to determine the effect of education on knowledge and self-care behaviors of patients with heart failure and included 80 patients were randomly assigned to experimental (n=40) and control (n=40) groups. First, demographic, knowledge and performance data were collected by interview and observation. Then, the case group experienced an educational program but control patients received routine care. One month after discharge from two groups took the final test. The level of knowledge and performance was poor before intervention and there was no significant difference between two groups. While the mean scores in control group and case group were significantly different after the intervention. The comparison of changes in the case group was significantly more than the control group that represents the positive effect educa
    Procedia - Social and Behavioral Sciences 12/2012; 31. DOI:10.1016/j.sbspro.2011.12.169
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Unplanned readmissions affect occupancy rates in medical wards and these have been constantly increasing in Israel. We examined the frequency and risk factors affecting the likelihood of 30-day emergency medical readmissions. We compared the clinical, epidemiological, and socioeconomic characteristics of readmitted patients during 2009 to a control group matched by age, sex, and primary medical diagnosis. Rate of unplanned readmissions within 30 days was 12.2%. The mean time to readmission was 12.8 days. The mean length of hospital stay at index admission was 4.4 and 3.8 days for the study and control groups, respectively, and 4.99 days in the second admission (study group only). By simple univariate logistic regression, living in a nursing home, chronic kidney disease, ischemic heart disease, previous cerebrovascular accident, number of chronic medications, length of hospital stay at index admission, and hospitalization in the previous year prior to index admission were significantly associated with risk of readmission. In multivariate logistic regression model, only living in a nursing home (OR=2.94, 95%CI=1.15-7.48), presence of chronic kidney disease (OR=1.62, 95%CI=1.06-2.46), length of index admission ≥ 3 days (OR=1.53, 95%CI=1.07-2.2), and hospitalization in the previous year (OR=3.33, 95%CI=2.34-4.74) were found to be significantly associated with likelihood of readmission. Risk factors affecting 30-days readmission at our medical centre are similar to previous observations, and yet, some are perhaps unique to our region.
    European Journal of Internal Medicine 07/2012; 23(5):457-60. DOI:10.1016/j.ejim.2012.03.004 · 2.30 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aging is associated with losses in hearing and vision. The objective of this study was to assess whether aging also is associated with less ability to detect and interpret afferent physiological information. A cross-sectional mixed methods study was conducted with 29 persons with a confirmed diagnosis of chronic heart failure of at least 6 months duration. The sample was divided at the median to compare younger (<73 years) versus older (> or = 73 years) patients in the ability to detect and interpret their heart failure symptoms. Shortness of breath was stimulated using a 6-minute walk test (6MWT) and used to assess the ability of heart failure patients to detect shortness of breath using the Borg measure of perceived exertion compared with gold standard ratings of each person's shortness of breath by trained registered nurse research assistants (inter-rater congruence 0.91). Accuracy of ratings by older patients was compared with those of younger patients. In-depth interviews were used to assess symptom interpretation ability. Integrated quantitative and qualitative data confirmed that older patients had more difficulty in detecting and interpreting shortness of breath than younger patients. Older patients were twice as likely as younger to report a different level of shortness of breath than that noted by the registered nurse research assistants immediately after the 6MWT. These results support our theory of an age-related decline in the ability to attend to internal physical symptoms. This decline may be a cause of poor early symptom detection. The results of this study suggest that there is a need to develop interventions that focus on the symptom experience to help patients-particularly older ones-in somatic awareness and symptom interpretation. It may be useful to explore patients' statements about how they feel: "Compared to what? How do you feel today compared to yesterday?"
    Journal of Nursing Scholarship 03/2010; 42(1):92-100. DOI:10.1111/j.1547-5069.2010.01333.x · 1.77 Impact Factor